Gonzalez J S, Delahanty L M, Safren S A, Meigs J B, Grant R W
Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, One Bowdoin Square, Boston, MA 02114, USA.
Diabetologia. 2008 Oct;51(10):1822-5. doi: 10.1007/s00125-008-1113-x. Epub 2008 Aug 9.
AIMS/HYPOTHESIS: The aim of this study was to examine the relationship between depressive symptoms and diabetes-specific distress and the independent relationships of each of these factors with diabetes self-care. We expected that symptoms of depression would be associated with poorer diabetes self-care, independent of diabetes-specific distress.
We surveyed 848 primary care patients with type 2 diabetes using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), Problem Areas in Diabetes scale (PAID), Summary of Diabetes Self-Care Activities, and self-reported medication adherence.
The PAID and HANDS scores were positively correlated in the overall sample (r=0.54, p<0.0001), among those who did not meet diagnostic criteria for major depressive disorder (MDD) based on the HANDS screening result (n=685; r=0.36, p<0.001) and in patients who did meet the screening criteria for MDD (n=163; r=0.36, p<0.001). Higher PAID scores significantly predicted lower levels of diet, exercise and medication adherence (all p values <0.05). However, once depression symptom scores were entered into these models, most relationships were reduced to non-significance, while the HANDS score retained significant relationships with most indices of diabetes self-care. The same pattern of results was found in the subset of patients who did not screen positive for MDD.
CONCLUSIONS/INTERPRETATION: These results suggest that specific symptoms of depression have a greater negative relationship with diabetes self-care than diabetes-specific distress, even among those patients who do not meet screening criteria for MDD. Interventions that focus on improving the management of specific symptoms of depression may be more effective in improving self-care than those that focus on reducing distress.
目的/假设：本研究旨在探讨抑郁症状与糖尿病特异性困扰之间的关系，以及这些因素各自与糖尿病自我管理的独立关系。我们预计，抑郁症状会与较差的糖尿病自我管理相关，且独立于糖尿病特异性困扰。
我们使用哈佛精神病学系/全国抑郁症筛查日量表（HANDS）、糖尿病问题领域量表（PAID）、糖尿病自我管理活动总结以及自我报告的药物依从性，对848名2型糖尿病初级护理患者进行了调查。
在总体样本中（r = 0.54，p < 0.0001）、基于HANDS筛查结果未达到重度抑郁症（MDD）诊断标准的患者中（n = 685；r = 0.36，p < 0.001）以及达到MDD筛查标准的患者中（n = 163；r = 0.36，p < 0.001），PAID和HANDS得分呈正相关。较高的PAID得分显著预测了饮食、运动和药物依从性水平较低（所有p值 < 0.05）。然而，一旦将抑郁症状评分纳入这些模型，大多数关系不再显著，而HANDS得分与大多数糖尿病自我管理指标仍保持显著关系。在未筛查出MDD阳性的患者子集中也发现了相同的结果模式。
结论/解读：这些结果表明，即使在未达到MDD筛查标准的患者中，抑郁的特定症状与糖尿病自我管理的负相关关系也比糖尿病特异性困扰更大。专注于改善抑郁特定症状管理的干预措施可能比专注于减轻困扰的干预措施在改善自我管理方面更有效。
